maurizio de luca md department of surgery – regional hospital of vicenza – italy department of...
Post on 12-Dec-2015
217 Views
Preview:
TRANSCRIPT
Maurizio De Luca MD
Department of Surgery – Regional Hospital of Vicenza – ItalyDepartment of Surgery – Regional Hospital of Vicenza – Italy
XXI Congresso Nazionale SICOb
Cagliari, 25-27 Aprile 2013
Mini Gastric Bypass: l’opinione degli esperti
La gestione delle complicanze. Esperienza personale e letteratura a confronto
Maurizio De Luca
Results of Mini Gastric Bypass – Vicenza Padova Background
Our Series before Mini Gastric Bypass
Our Primary Surgery
Sept 1993 Dec 2012 : Gastric Banding → 2400 Patients
0 moratility 5.4% complication requiring reoperation Mean %EWL 49% at 12 years 25% of GB with %EWL < 30 (failure)
APPROPRIATE BARIATRIC OPERATION – POSSIBLE ROLE OF STAGED SURGERYM DE LUCA, G Segato, L Busetto, D Asthon, F Favretti.Obesity Surgery, 18, 4, 153, 471-472, 2008
Maurizio De Luca
Our Series before Mini Gastric Bypass
Our Remedial Surgery from Dec 1995 to January 2011
Duodenal Switch (DS) → 155 Patients (F/M 98/57) open/VLS 41/114 VLS from Jan 20010,7% mortality (1 case for malignant hypertermia)16.7% post-op surgical complication (fistula, bleeding, internal hernia) 5.5% post-op medical complication (non fatal PE, pneumoniae, ARDS, MI) 3% surgical revisions (diarrhea, low protein,excess WL, poor WL) 12.5% metabolic complication requiring rehospitalization
arthralgia, peripheral edema, vomiting, diarrhea, nutrients deficiences39% of patients proctitis, alitosis, acid sweating
75% EWL 13 years follow up Comorbidities resolution 94% hyperlipemia, 91% Type II Diabetes
ADJUSTABLE GASTRIC BANDING WITH DUODENAL SWITCH (BANDINARO): SEQUENTIAL TREATMENT IN A FAILED RESTRICTIVE PROCEDURE (LAPAROSCOPIC PRELIMINARY EXPERIENCE) DE LUCA M, Segato G, Busetto L, Ceoloni A, Banzato O, Enzi G, Favretti F Obesity Surgery, 16,4,2006, 400.
Results of Mini Gastric Bypass – Vicenza Padova Background
Maurizio De Luca
Results of Mini Gastric Bypass
Mini Gastric Bypass : Vicenza Hospital /Padova University Series
Antrophometric Data
• April 2011 – December 2012 (20 months experience)• 42 Patients (F/M 26/16)
• Primary Surgery /Remedial Surgery for Band Failure 4/38
• Age 39.7 ± 10 (19-62)• Weight kg 138.7 ± 26.8 (93-182) • BMI 45.6 ± 8.1 (35-61)• Lap/Open 42/0• Skin-to Skin Time 110 ± 4.65 (85-190)
No published data
Maurizio De Luca
Results of Mini Gastric Bypass - Technical Details
Performed by Laparoscopy (4-5 Trocar)
20-30 ml Gastric pouch (vertical gastrectomy)
Gastro-jejunal anastomosis with a stoma diameter of 1.5-2 cm
L-L anastomosis
Antireflux Stitches
Omega Loop 220 cm
Antecolic anastomosis
One Anastomosis Gastric Bypass: a simple, safe and efficient surgical procedure for treating morbid obesityM Garcia Caballero and M CarbajoNutricion Hospitalaria, XIX, (6) 372-375, 2004
Maurizio De Luca
Results of Mini Gastric Bypass as Remedial Surgery Weight Loss (38 Pts)
Kg
months
Maurizio De Luca
Results of Mini Gastric Bypass as Remedial Surgery Weight Loss (38 Pts)
% EWL
months
Maurizio De Luca
Results of Mini Gastric Bypass (42 Pts)
Comorbidities
Diabetes
12 obese Pts DM2 3 years, HgA1c > 7.5%Failure previous medical treatment
Mean Follow-up: 13 .1months (±2.3)
Dyslipidemia
11 obese Pts with hypercolesterolemia and/or hypertrygliceridemia
Mean Follow-up: 12.4months (±1.9)
Complete Remission: 9 pts (75%)
Improvement: 12 pts (100%)
Complete remission 10 pts (90.1%)
OSAS 5 pts Complete resolution 100%
Sonnolence 7 pts Complete resolution 100%
Hypertension 19 pts Complete resolution 78%Partial resolution 10%
Hyperuricemia 3 pts Complete resolution 100%
Fatty liver 10 pts Ultrasound at 0 and 12 months
Improvement 90%
Maurizio De Luca
Results of Mini Gastric Bypass (42 Pts)
Comorbidities
Maurizio De Luca
Results of Mini Gastric Bypass – Vicenza Padova Series
Dolen K et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg 2004; 240-51
Slater GH, Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointestinal Surg 2004; 8: 48-65
APPROPRIATE BARIATRIC OPERATION – POSSIBLE ROLE OF STAGED SURGERYM DE LUCA, G Segato, L Busetto, D Asthon, F Favretti.Obesity Surgery, 18, 4, 153, 471-472, 2008
Nutritional Deficiences
IronCalciumZincVitaminDVitamin A Vitamin KProtein
Maurizio De Luca
Results of Mini Gastric Bypass – Vicenza /Padova Series
Complication of MGB
Short Term Complications Leakage 0 4.7% Omega loop Bleeding 0 2.3% abdominal, intraluminal, thoracic Major atelectasis 0 0 Deep vein thrombosis 0 0 Death 0 0
Long Term Complications (0 redo) Stomal Ulcer 0 0 Bile Reflux 0 2.3% Excessive Weight Loss (malnutrition) 2.3% 0 Bowel obstruction 0 0
Total Redo Surgery (1 Pts 1° day post-op) 2.3%
Primary MGB 4 Pts Revisional 38 Pts
Not published data
Maurizio De Luca
Results of Mini Gastric Bypass – Vicenza /Padova Series
Side Effects of MGB
Asthenia 0 7.7% <0.001 Diarrhea 2.3% 2.3% <0.001 Bloating 0 4.7% <0.01 Epigastralgia 2.3% 4.7% <0.05 Vomiting 0 2.3% <0.01
Major metabolic consequences 0 0
Primary MGB 4 Pts Revisional 38 Pts
Not published data
Maurizio De Luca
Results of Mini Gastric Bypass - Literature
Complication of MGB
Short Term Complications (6 redo) 2.7% 11% <0.001 Leakage 0.4% 3.8% <0.001 Gastrojejunostomy, gastric tube, gastric remnant Bleeding 1.6% 6.4% <0.68 abdominal, intraluminal, thoracic Major atelectasis 0.21% 1.29% <0.09 Deep vein thrombosis 0.1% 0% <0.77 Death 0 0
Long Term Complications (7 redo) 0.69% 5.2% <0.03 Stomal Ulcer 0.65% 0 <0.102 Bile Reflux 0 5.2% <0.001 Excessive Weight Loss (malnutrition) 0,4% 0 <0.001 Bowel obstruction 0 0 <0.562
Primary MGB 923 Pts Revisional 77 Pts
ONE THOUSANDS CONSECUTIVE MINI-GASTRIC BYPASS. SHORT AND LONG TERM OUTCOMENoun R, Skaff J, Riachi EObesity Surg, 22, 697-703, 2012
Maurizio De Luca
Results of Mini Gastric Bypass - Literature
Complication of MGB
Short Term Complications 1.4% Leakage 0.9% Gastrojejunostomy, gastric tube, gastric remnant Bleeding 0.3% abdominal, intraluminal, thoracic Gastric Perforation 0.1% Death 0.1% 1 pulmonary thromboembolism/ 1 gastric wall necrosis
Long Term Complications 0.8% Stomal Ulcer 0.4% Gastrojejunal stenosis 0.4%
Total Redo Surgery 1.3%
Primary/Revisional MGB 1126 Pts
BYPASS GASTRICO LAPAROSCOPICO DE UNA SOLA ANASTOMOSIS (BAGUA) ASISTIDOCON BRAZO ROBOTICO:TECNICA Y RESULTATOS EN 1126 PACIENTESCaballero MAC, De Solorzano JO, Garcia-Lanza CCirurgia Endoscopica, 9,1, 6-13, 2008
Maurizio De Luca
Maurizio De Luca
Lee WJ et al.Laparoscopic Roux en Y Gastric Bypass vs Mini Gastric Bypass for the treatment of Morbid Obesity: a 10 Years experienceObesity Surgery 22: 1827-1834, 2012
Lee GBP vs MGP: 10 year results - Complication
Maurizio De Luca
Lee WJ et al.Laparoscopic Roux en Y Gastric Bypass vs Mini Gastric Bypass for the treatment of Morbid Obesity: a 10 Years experienceObesity Surgery 22: 1827-1834, 2012
Lee GBP vs MGP: 10 year results Weight Loss
Maurizio De Luca
Lee WJ et al.Laparoscopic Roux en Y Gastric Bypass vs Mini Gastric Bypass for the treatment of Morbid Obesity: a 10 Years experienceObesity Surgery 22: 1827-1834, 2012
Lee GBP vs MGP: 10 year results
Maurizio De Luca
Results of Mini Gastric Bypass – Conclusion 1
Less Surgery compared to GBP and BPD
Quicker Surgery compared to GBP and BPD
Low peri-operative complications compared to GBP and BPD
Long Term Weight Loss as BPD (75% EWL at 10 yrs)
Remission /improvement of Diabetes in 85-90 % of cases
Remission of hyperlipidemia in 85-95% of cases
Absence of some BPD side effects (like diarrhea, hemorrhoids, proctitis etc.)
Reduction of metabolic consequences of BPD (protein malnutrition)
Maurizio De Luca
Results of Mini Gastric Bypass – Conclusion 2
In our series first choice operation is Gastric Banding (72% of Pts)
First option for Bile Reflux Obese Pts is GBP
First option for Diabetic or Hyperlipemic Obese Pts is MGB
First option as remedial surgery is MGB
Current studiies show that MGB is an effective, low-risk and low-failure bariatric procedure
MGB can be revised in GBP or reversed if necessary
Maurizio De Luca
Results of Mini Gastric Bypass
Thank You for your attention
top related